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Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II–III Rectal Cancer

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Stage II–III rectal cancer requires multidisciplinary cancer care, and adolescents and young adults (AYA, ages 15–39 years) often do not receive optimal cancer therapy.

Methods

Overall, 3295 AYAs with clinical stage II–III rectal cancer were identified in the National Cancer Database. Factors associated with the receipt of adjuvant and surgical therapies, as well as overall survival (OS), were examined.

Results

The majority of patients were non-Hispanic White (72.0 %), male (57.5 %), and without comorbidities (93.8 %). A greater proportion of Black and Hispanic patients did not receive radiation (24.5 and 27.1 %, respectively, vs. 16.5 % for non-Hispanic White patients), surgery (22.4 % and 21.6 vs. 12.3 %), or chemotherapy (21.5 % and 24.1 vs. 14.7 %) compared with non-Hispanic White patients (all p < 0.05). After controlling for competing factors, Black (odds ratio [OR] 0.7, 95 % confidence interval [CI] 0.5–0.9) and Hispanic patients (OR 0.6, 95 % CI 0.4–0.9) were less likely to receive neoadjuvant chemoradiation compared with non-Hispanic White patients. Females, the uninsured, and those treated at a community cancer center were also less likely to receive neoadjuvant therapy. Having government insurance (OR 0.22, 95 % CI 010–0.49) was a predictor for not receiving surgery. Although 5-year OS was lower (p < 0.05) in Black (59.8 %) and Hispanic patients (65.9 %) compared with non-Hispanic White patients (74.9 %), on multivariate analysis race did not impact mortality. Not having surgery (hazard ratio [HR] 7.1, 95 % CI 2.8–18.2) had the greatest influence on mortality, followed by poorly differentiated histology (HR 3.0, 95 % CI 1.3–6.5), nodal positivity (HR 2.6, 95 % CI 1.9–3.6), no chemotherapy (HR 1.9, 95 % CI 1.03–3.6), no insurance (HR 1.7, 95 % CI 1.1–2.7), and male sex (HR 1.5, 95 % CI 1.1–2.0).

Conclusion

There are racial and socioeconomic disparities in the treatment of stage II–III rectal cancer in AYAs, many of which impact OS. Interventions that can address and mitigate these differences may lead to improvements in OS for some patients.

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References

  1. Shapiro NL, Bhattacharyya N. Population-based outcomes for pediatric thyroid carcinoma. Laryngoscope. 2005;115:337–40.

    Article  PubMed  Google Scholar 

  2. Singh KE, Taylor TH, Pan CG, Stamos MJ, Zell JA. Colorectal cancer incidence among young adults in California. J Adolesc Young Adult Oncol. 2014;3:176–84.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bailey CE, Hu CY, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg. 2015;150:17–22.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nass SJ, Beaupin LK, Demark-Wahnefried W, et al. Identifying and addressing the needs of adolescents and young adults with cancer: summary of an Institute of Medicine workshop. Oncologist. 2015;20:186–95.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bleyer A. Young adult oncology: the patients and their survival challenges. CA Cancer J Clin. 2007;57:242–55.

    Article  PubMed  Google Scholar 

  6. Thomas DM, Seymour JF, O’Brien T, Sawyer SM, Ashley DM. Adolescent and young adult cancer: a revolution in evolution?. Intern Med J. 2006;36:302–07.

    Article  CAS  PubMed  Google Scholar 

  7. <20101222094132964.pdf > .

  8. Bleyer A, Budd T, Montello M. Adolescents and young adults with cancer: the scope of the problem and criticality of clinical trials. Cancer. 2006;107:1645–55.

    Article  PubMed  Google Scholar 

  9. Albritton K, Bleyer WA. The management of cancer in the older adolescent. Eur J Cancer. 2003;39:2584–99.

    Article  CAS  PubMed  Google Scholar 

  10. Boissel N, Auclerc MF, Lheritier V, et al. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol. 2003;21:774–80.

    Article  PubMed  Google Scholar 

  11. Sabounchi S, Keihanian S, Anand BS. Impact of race on colorectal cancer. Clin Colorectal Cancer. 2012;11:66–70.

    Article  PubMed  Google Scholar 

  12. Krieger N, Quesenberry C Jr, Peng T, et al. Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988–92 (United States). Cancer Causes Control. 1999;10:525–37.

    Article  CAS  PubMed  Google Scholar 

  13. Pahlman L, Glimelius B. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980–7.

    Article  Google Scholar 

  14. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U, et al. Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23:5644–50.

    Article  PubMed  Google Scholar 

  15. Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27:5124–30.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Albano JD, Ward E, Jemal A, et al. Cancer mortality in the United States by education level and race. J Natl Cancer Inst. 2007;99:1384–94.

    Article  PubMed  Google Scholar 

  17. Hao Y, Jemal A, Zhang X, Ward EM. Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States). Cancer Causes Control. 2009;20:1855–63.

    Article  PubMed  Google Scholar 

  18. Berry J, Bumpers K, Ogunlade V, et al. Examining racial disparities in colorectal cancer care. J Psychosoc Oncol. 2009;27:59–83.

    Article  PubMed  Google Scholar 

  19. Polite BN, Dignam JJ, Olopade OI. Colorectal cancer model of health disparities: understanding mortality differences in minority populations. J Clin Oncol. 2006;24:2179–87.

    Article  PubMed  Google Scholar 

  20. Pacini F, Schlumberger M, Harmer C, et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol. 2005;153:651–59.

    Article  CAS  PubMed  Google Scholar 

  21. Williams RT, Stewart AK, Winchester DP. Monitoring the delivery of cancer care: Commission on Cancer and National Cancer Data Base. Surg Oncol Clin N Am. 2012;21:377–88.

    Article  PubMed  Google Scholar 

  22. Yin D, Morris C, Allen M, Cress R, Bates J, Liu L, et al. Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups? Cancer Causes Control. 2010;21:1721–30.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Glanz K, Croyle RT, Chollette VY, Pinn VW. Cancer-related health disparities in women. Am J Public Health. 2003;93:292–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gross CP, Smith BD, Wolf E, Andersen M. Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer. 2008;112:900–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wheeler SB, Reeder-Hayes KE, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18:986–93.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kish JK, Yu M, Percy-Laurry A, Altekruse SF. Racial and ethnic disparities in cancer survival by neighborhood socioeconomic status in Surveillance, Epidemiology, and End Results (SEER) Registries. J Natl Cancer Inst Monogr. 2014;2014:236–43.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54:78–93.

    Article  PubMed  Google Scholar 

  28. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.

    Article  CAS  PubMed  Google Scholar 

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Author Contributions

Study conception and design: Drs. Lee, Attaluri, McLemore, Stern, Bilchik, and Goldfarb. Acquisition of data: Drs. Lee, Teng, Pederson, and Tavangari. Analysis and interpretation of data: Drs. Lee, Teng, Pederson, Tavangari, Stern, Bilchik, and Goldfarb. Drafting of the manuscript: Drs. Lee, Teng, Pederson, Tavangari, and Goldfarb. Critical revision: Drs. Attaluri, McLemore, Bilchik, and Goldfarb.

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Authors and Affiliations

  1. Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA, USA

    David Y. Lee MD, Anton J. Bilchik MD, PhD & Melanie R. Goldfarb MD, MSc, FACS, FACE

  2. Department of Surgery, Mount Sinai St. Luke’s and Mount Sinai Roosevelt Hospital Center, New York, NY, USA

    Annabelle Teng MD

  3. Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Rose C. Pedersen MD, Farees R. Tavangari MD, Vikram Attaluri MD & Elisabeth C. McLemore MD

  4. Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA, USA

    Stacey L. Stern MS

Authors
  1. David Y. Lee MD
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  2. Annabelle Teng MD
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  3. Rose C. Pedersen MD
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  4. Farees R. Tavangari MD
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  5. Vikram Attaluri MD
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  6. Elisabeth C. McLemore MD
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  7. Stacey L. Stern MS
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  8. Anton J. Bilchik MD, PhD
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  9. Melanie R. Goldfarb MD, MSc, FACS, FACE
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Corresponding author

Correspondence to Melanie R. Goldfarb MD, MSc, FACS, FACE.

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Disclosure

The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Lee, D.Y., Teng, A., Pedersen, R.C. et al. Racial and Socioeconomic Treatment Disparities in Adolescents and Young Adults with Stage II–III Rectal Cancer. Ann Surg Oncol 24, 311–318 (2017). https://doi.org/10.1245/s10434-016-5626-0

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  • DOI: https://doi.org/10.1245/s10434-016-5626-0

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